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Öğe Assessment of the relationship between red cell distribution width and fragmented QRS in patients with non-ST elevated acute coronary syndrome(Int Scientific Literature, Inc, 2014) Bekler, Adem; Gazi, Emine; Tenekecioglu, Erhan; Karaagac, Kemal; Altun, Burak; Temiz, Ahmet; Barutcu, AhmetBackground: Red cell distribution width (RDW) and fragmented QRS (fQRS) complexes have also been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD). We aimed to investigate the association of serum red cell distribution width (RDW) levels and fQRS in patients with non-ST elevated acute coronary syndrome (NST-ACS). Material/Methods: We retrospectively evaluated a total of 251 patients (191 men and 60 women) with NST-ACS. The NST-ACS consisted of unstable angina (UA) and non-ST elevated myocardial infarction (NSTEMI). The fQRS pattern was defined as the presence of an additional R' or crochetage wave, notching in the nadir of the S wave or fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationships between the RDW and fQRS were assessed. Results: The patients in the fQRS group were older, left ventricular ejection fraction (LVEF) levels were significantly lower, and baseline RDW and troponin levels were significantly higher than in the group without fQRS. There were positive correlations between age, number of coronary arteries narrowed, and RDW, and negative correlations between triglyceride, LVEF, and RDW in study patients. There were positive correlations between number of fQRS leads, age, and RDW, and negative correlations between triglyceride, LVEF, and RDW in NSTEMI patients. Conclusions: Our results indicate that an elevated RDW values is associated with fQRS in NST-ACS. Elevated RDW values and fQRS together may be useful for identifying NSTEMI patients in NST-ACS.Öğe Microalbuminuria in untreated prehypertension and hypertension without diabetes(E-Century Publishing Corp, 2014) Tenekecioglu, Erhan; Yilmaz, Mustafa; Yontar, Osman Can; Karaagac, Kemal; Agca, Fahriye Vatansever; Tutuncu, Ahmet; Kuzeytemiz, MustafaObjective: Hypertension (HT) and prehypertension (preHT) were independent predictors of cardiovascular diseases. Urinary albumin leakage is a manifestation of generalized vascular damage. B-type natriuretic peptide (BNP) is a vasoactive peptide secreted by left ventricle in response to myocytic stretch. We aimed to investigate relationship between microalbuminuria (MA) and BNP in untreated elevated blood pressures. Methods: Of 105 untreated prehypertensive subjects (53 men, 52 women), 100 hypertensive subjects (51 men, 49 women) and 57 normotensive subjects (32 men, 25 women) none had history of diabetes. Urine albumin excretion was measured by immunoradiometric assay in morning urine sample. Results: The prevalence of MA was higher in hypertensive group than in prehypertensive group and in normotensive group (Hypertensive group; 33.9%, prehypertensive; 25.9%, normotensive; 10%). Subjects with HT had higher prevalence of microalbminuria; larger body mass index, higher levels of triglycerides, blood glucose and creatinin were more common in subjects with HT than in those with preHT. In hypertensive group; patients with microalbuminuria had higher systolic blood pressure (SBP), BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (beta: 0.361; P < 0.001), LVMII (beta: 0.267; P = 0.011) and BNP (beta: 0.284; P = 0.005) were independent variables associated with MA in hypertensives. In prehypertensive group; patients with microalbuminuria had higher SBP, BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (beta: 0.264; P = 0.002), LVMI (beta: 0.293; P = 0.001) and BNP (beta: 0.168; P = 0.045) were associated with MA in prehypertensives. Conclusions: In preHT and HT, SBP, BNP and LVMI are associated with MA. In the evaluation of increased blood pressures, in case of increased BNP and LVMI, MA should be investigated even in prehypertensive stages. The subjects with increased blood pressures should get medical treatment to prevent the effects on vascular structure and myocardium even in prehypertensive phase.Öğe Predictors of coronary collaterals in patients with non ST-ellevated acute coronary syndrome: the paradox of the leukocytes(Termedia Publishing House Ltd, 2014) Tenekecioglu, Erhan; Yilmaz, Mustafa; Karaagac, Kemal; Bekler, Adem; Aslan, Burhan; Demir, Serafettin; Kuzeytemiz, MustafaAim of the study: Atherosclerosis represents active inflammation in which leukocytes play significant role. Coronary collateral development is a response to myocardial ischaemia. In this study we aimed to investigate the association of the leukocytes with coronary collateral development in patients with non ST-elevated acute coronary syndromes (NST-ACS). Material and methods: A total of 251 consecutive patients were hospitalized in our hospital with a diagnosis of NST-ACS. The blood samples were collected 1-hour after admission to the hospital and peripheral leukocytes (neutrophils, monocytes and lymphocytes) were examined. All patients underwent coronary angiography. The coronary collateral vessels (CCV) are graded according to the Rentrop scoring system. Results: Group 1 consisted of 146 patients with Rentrop 0 and Group 2 consisted of 105 patients with Rentrop I, 2 and 3. The presence of CCV was significantly associated with neutrophil count, lymphocyte count, monocyte count and neutrophil-lymphocyte ratio (NLR). In subgroup analyses, higher NLR was significantly associated with good CCV development in patients with NST-ACS. Conclusions: Higher neutrophil count, monocyte count and NLR and lower lymphocyte count on admission, were associated with the presence of CCV in patients with NST-ACS. High NLR may predict good collateral development in patients with NST-ACS.Öğe Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome(Hospital Clinicas, Univ Sao Paulo, 2015) Tenekecioglu, Erhan; Yilmaz, Mustafa; Yontar, Osman Can; Bekler, Adem; Peker, Tezcan; Karaagac, Kemal; Ozluk, Ozlem AricanOBJECTIVES: The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome. METHODS: We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels. RESULTS: The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6 +/- 1.0 vs 13.06 +/- 1.7, respectively; p=0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p=0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p=0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r=0.19; p=0.006). CONCLUSION: A greater baseline red cell distribution width value was associated with myocardial injury and elevated cardiac troponin I levels in non-ST-elevation acute coronary syndrome. Therefore, the red cell distribution width could be considered for risk stratification of acute coronary syndrome patients admitted to emergency departments.
